title: Delayed cardiac tamponade after open heart surgery - is supplemental CT imaging reasonable?
abstract: BACKGROUND
  Cardiac tamponade is a severe complication after open heart surgery. Diagnostic imaging is challenging in postoperative patients, especially if tamponade develops with subacute symptoms. Hypothesizing that delayed tamponade after open heart surgery is not sufficiently detected by transthoracic echocardiography, in this study CT scans were used as standard reference and were compared with transthoracic echocardiography imaging in patients with suspected cardiac tamponade.
  
  
  METHODS
  Twenty-five patients after open heart surgery were enrolled in this analysis. In case of suspected cardiac tamponade patients underwent both echocardiography and CT imaging. Using CT as standard of reference sensitivity, specificity, positive and negative predictive values of ultrasound imaging in detecting pericardial effusion/hematoma were analyzed. Clinical appearance of tamponade, need for re-intervention as well as patient outcome were monitored.
  
  
  RESULTS
  In 12 cases (44%) tamponade necessitated surgical re-intervention. Most common symptoms were deterioration of hemodynamic status and dyspnea. Sensitivity, specificity, positive and negative predictive values of echocardiography were 75%, 64%, 75%, and 64% for detecting pericardial effusion, and 33%, 83%, 50, and 71% for pericardial hematoma, respectively. In-hospital mortality of the re-intervention group was 50%.
  
  
  CONCLUSIONS
  Diagnostic accuracy of transthoracic echocardiography is limited in patients after open heart surgery. Suplemental CT imaging provides rapid diagnostic reliability in patients with delayed cardiac tamponade.
authors.affiliation: Department Cardiothoracic Surgery, University Medical Center Regensburg 93053, Regensburg, Germany. bernhard.floerchinger@ukr.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Floerchinger
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Simon
authors.initials: S
authors.lastname: Schopka
authors.forename: Philipp
authors.initials: P
authors.lastname: Kolat
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging*; D004452:Echocardiography; D006801:Humans; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome